Figure 5  .

Ebstein's anomaly. From a modified four chamber view at the gastro-oesophageal junction (A), the right atrium is seen to be severely dilated. The closed arrows indicate the level of the tricuspid annulus. There is atrialisation of a large part of the right ventricular cavity. The septal leaflet is displaced downward from the annulus (*) and the anterosuperior tricuspid valve leaflet is large and abnormally tethered to the right ventricular wall (open arrows). In B, colour flow mapping reveals very severe tricuspid regurgitation, through a regurgitant orifice well below the tricuspid valve annulus. Oblique views of the right sided structures are often helpful; C shows multiple abnormal "chordae" tethering the large anterosuperior leaflet to the right ventricular wall (*). In systole (D), severe tricuspid regurgitation is seen through two regurgitant orifices (that is, two flow convergence zones). RA, right atrium; RV, right ventricle; LV, left ventricle; RVOT, right ventricular outflow tract.